Project Summary/Abstract Worldwide, there are over one billion people with a disability, of these roughly 80% residents of low- and middle-income countries. People with disabilities continue to encounter challenges to accessing and utilizing essential health services. Women with disabilities in particular experience greater barriers to getting their maternal health needs met, and face unique complications related to pregnancy and childbearing, compared to women without disabilities. In Uganda, despite enactment of the national Persons with Disabilities Act in 2006, women with disabilities continue to face physical inaccessibility, negative attitudes of health workers, high health service costs, and marginalization, which impede their ability to access quality and affordable health care. The Equitable Maternal Care for Women with Disability (EMeralD) study is designed to collect and analyze quantitative and qualitative evidence to develop a model for disability-friendly services that address barriers to accessing maternal health care by pregnant women with disabilities to improve outcomes in Uganda. The study team from Johns Hopkins Bloomberg School of Public Health (JHU), USA, Makerere University School of Public Health (MUSPH), Uganda, and Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS), Uganda, will explore the lived experiences and barriers to access and utilization of maternal health care services (i.e., care received during pregnancy, childbirth and the postpartum period) of pregnant women with disabilities, and apply the findings to develop a program for disability-friendly services that can be piloted at IM-HDSS and other districts in Uganda. This project has 3 specific aims. (1) We will conduct an analysis of disability, pregnancy and birth outcomes, and maternal health care utilization data for pregnant women with disabilities in Uganda, combining available quantitative data on service utilization and disability. Our analysis will clarify the incidence and outcomes of pregnancy in women with disabilities, types and causes of their disability, availability and access to maternal care services during pregnancy, and any unmet needs. (2) We will conduct qualitative research (key informant interviews with district health officials and community leaders; in-depth interviews with women with disabilities who are currently pregnant or have delivered in the previous 1 year, and their caregivers; and focus group discussions) to understand the needs and perceptions of pregnant women with disabilities and identify facilitators of and and barriers to access to maternal health care services. (3) Using the findings of Aims 1 and 2, we will develop a model for disability- friendly services for pregnant women, using a community-based service model to be implemented at the district level. To identify key factors and components for building a disability-friendly health services programs for local stakeholders, we will hold a peer review workshop to finalize a locally and culturally appropriate model for Uganda. We intend to apply for an R01 to pilot the model in multiple districts in Uganda and assess its effectiveness.